An investigation by the British Medical Journal has allegedly found evidence to suggest that drug giant Novartis is trying to interfere with the use of off-label Avastin (bevacizumab) in the UK to treat a common eye disorder, in order to protect the market position of its much more expensive but licensed offering Lucentis (ranibizumab).

The National Health Service currently shells out a whopping £244 million a year on Lucentis to treat wet age-related macular degeneration, but the use of Avastin instead could save the system a massive £102 million.

Both drugs are vascular endothelial growth factor (VEGF) inhibitors owned by Roche, but Novartis has rights to sell Lucentis in Europe. Avastin is only licensed for use in cancer, and Roche has consistently refused to pursue the wet AMD indication for the drug despite pressure from all sides to do so, leaving doctors with no option but to prescribe it ‘off-label’.

Now, evidence uncovered by the BMJ seems to suggest that Novartis is trying to undermine publicly-funded research proving that these drugs have equal efficacy and safety profiles. The publication claims that emails it obtained under a freedom of information request show that clinicians with ties to Novartis allegedly urged some primary care trusts to pull out of one such trial. 

The BMJ has also learnt of attempts by Novartis to "derail" a second study. The trial's chief investigator, Alex Foss, a consultant ophthalmologist at Queen's Medical Centre, Nottingham, has reported being approached during the trial's planning stage by a Novartis representative who allegedly tried to divert him to its own funded work, dangling a carrot of future cash for personal research projects.

Allegations denied

Novartis has reportedly denied the allegations, but there are also other external factors at play preventing Avastin’s wider use for wet AMD. For one, the General Medical Council has concluded that it is unlawful to prescribe an ‘unlicensed’ medicine on the grounds of cost alone, leaving doctors reluctant to act use the drug in this setting, despite supporting clinical evidence. 

BMJ editor in chief, Fiona Godlee, said “doctors and academics have carried out clinical trials despite threats and intimidation - and doctors leaders should follow suit and not allow themselves to be bullied either”.

“Doctors leaders also need to sort out the web of misinformation about drug prescribing that has been generated behind closed doors and is costing the NHS hundreds of millions of pounds a year by scaring doctors from using cheap and effective medicines,” she stressed.

In February it was revealed that around 60% of clinical commissioning groups in England have called on the GMC, Department of Health and NHS England to make it easier for them to prescribe Avastin for un-licensed use in wet AMD.